CLINICAL OUTCOMES WITH INSULIN LISPRO COMPARED WITH HUMAN REGULAR INSULIN - A METAANALYSIS

We performed a meta-analysis to compare insulin lispro and human regul ar insulin across a range of outcomes common in modem diabetes managem ent to establish a basis for subsequent economic evaluation. We includ ed all identifiable head-to-head randomized controlled trials, pooling dichotomous and continuous outcomes using appropriate statistical met hods. Measures associated with various aspects of glycemic control (pr eprandial and postprandial glycemic control, glucose excursion, and gl ycated hemoglobin) and with hypoglycemia were evaluated. Results showe d significant differences in favor of insulin lispro in the outcomes a ssociated with postprandial glycemic control without an increase in hy poglycemia. Outcomes associated with fasting glycemic control and over all long-term glycemic control were not significantly different betwee n insulin lispro and human regular insulin. Alternative approaches to the meta-analysis were explored but did not alter the conclusions. Thu s our meta-analysis supports the existence of significant differences between insulin lispro and human regular insulin in terms of important postprandial outcome measures in diabetes. In addition, there is a pr actical difference in injection timing relative to meals: human regula r insulin should be administered 30 to 45 minutes before eating, where as insulin lispro can be administered 15 minutes or less before eating . These differences should be the subject of an economic evaluation to assist in determining the place of insulin lispro in diabetes managem ent.